Hospitalizations during a physical activity intervention in older adults at risk of mobility disability: analyses from the lifestyle interventions and independence for elders randomized clinical trial

Authors: MARSH, ANTHONY - Wake Forest University; APPLEGATE, WILLIAM - Wake Forest University; GURALNIK, JACK - University Of Maryland; REJESKI, JACK - Wake Forest University; CHURCH, TIMOTHY - University Of Maryland; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; GILL, THOMAS - Yale University; KING, ABBY - Stanford University; KRITCHEVSKY, STEPHEN - Wake Forest University; MANINI, TODD - University Of Florida; MCDERMOTT, MARY - Northwestern University; NEWMAN, ANNE - University Of Pittsburgh; STOWE, CYNTHIA - Wake Forest University; WALKUP, MICHAEL - Wake Forest University; PAHOR, MARCO - University Of Florida; MILLER, MICHAEL - Wake Forest University

Submitted to: Journal of the American Geriatrics Society
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/27/2015
Publication Date: 5/25/2016
Citation: Marsh, A.P., Applegate, W.B., Guralnik, J.M., Rejeski, J.W., Church, T.S., Fielding, R.A., Gill, T.M., King, A.C., Kritchevsky, S.B., Manini, T.M., McDermott, M.M., Newman, A.B., Stowe, C.L., Walkup, M.P., Pahor, M., Miller, M.E. 2016. Hospitalizations during a physical activity intervention in older adults at risk of mobility disability: analyses from the lifestyle interventions and independence for elders randomized clinical trial. Journal of the American Geriatrics Society. (64)5:933-943. https://doi.org/10.1111/jgs.14114.
DOI: https://doi.org/10.1111/jgs.14114

Interpretive Summary: The purpose of this study was to determine if a moderate intensity physical activity (PA) program is associated with different rates and types of hospitalizations compared to a health education (HE) control group. We examined data from the Lifestyle Interventions and Independence for Elders (LIFE) study, a multicenter randomized controlled trial in which participants were randomized to a PA or HE program for an average of 2.6 years. There were 1,458 hospitalizations, and these were not different between the groups. A PA program in older adults at risk for mobility disability did not lead to a different risk of overall hospitalizations compared to the HE program.

Technical Abstract: Objectives: To determine whether moderate-intensity physical activity (PA) and health education (HE) are differentially associated with categories of hospitalizations or subgroups of participants. Design: Multicenter randomized controlled trial in which participants were randomized to a PA or HE program for an average of 2.6 years. Setting: Eight field centers. Participants: Sedentary men and women aged 70-89 with lower extremity physical limitations but able to walk 400-m in 15 minutes or less (N = 1,635). Interventions: Structured, moderate-intensity PA (n = 818) at a center (2x/wk) and at home (3-4x/wk) that included aerobic, strength, balance, and flexibility training or HE (n = 817) of educational workshops and upper extremity stretching exercises. Measurements: All-cause inpatient hospitalizations ascertained at 6-month intervals. Results: There were 1,458 hospitalizations (49.1% of PA, 44.4% of HE; risk difference = 4.68%, 95% confidence interval (CI) = -0.18-9.54; hazard ratio (HR) = 1.16, 95% CI = 1.00-1.34). The intervention effect on incident hospitalization did not differ according to race, sex, Short Physical Performance Battery score, age, or history of cardiovascular disease or diabetes mellitus. PA was associated with higher rates of hospitalization in the middle baseline gait speed category, than HE (<0.8 m/s: HR = 0.93, 95% CI = 0.76-1.14; 0.8-1.0 m/s: HR = 1.54, 95% CI = 1.23-1.94; >1.0 m/s: HR = 1.05, 95% CI = 0.67-1.65; interaction P = .005). Conclusion: A PA program in older adults at risk for mobility disability did not lead to a different risk of specific types of hospitalizations than a HE program overall. Baseline gait speed may be a marker for risk of hospitalization during a PA intervention, because individuals with moderate baseline gait speed in the PA group had slightly higher rates of hospitalization than those in the HE group.